Liposuction treats lipodystrophy and reduces the thickness of body contouring flaps. Patients are evaluated for suitability of deformity, skin quality, and understanding of the procedure. Inelastic and hanging skin is contraindicated for aesthetic lipoplasty. In general, a circumferential approach is taken to maximize skin shrinkage and harmonize the result. The traditional technique of suction-assisted lipectomy is presented with emphasis on smoothing and delivering the fat by the helping hand. Large volume liposuction requires attention to maintain normothermia, fluid balance, and deep vein thrombosis (DVT) prophylaxis. Of the special energy sources, power assisted, laser, and ultrasonic, the author prefers and elaborates on ultrasonic and radio-frequency usage. By reducing, undermining, and gentle fat removal, liposuction can safely and effectively be combined with extensive body contouring surgery.